Oklahoma Telemedicine Conference 2014: Telehealth Transition October 16, 2014 Cynthia Scheideman-Miller, MHSA Heartland Telehealth Resource Center

TELEMEDICINE REIMBURSEMENT: MEDICAID AND PRIVATE PAYERS

Who we are

Heartland Telehealth Resource Center

is an independent and impartial resource center that is here to assist in the development of sustainable telehealth programs and networks. Heartland is the regional TRC for Kansas, Missouri and Oklahoma.

HTRC activity is supported by grant number G22RH20214 from the Office for the Advancement of Telehealth, Office of Health Information Technology, Health Resources and Services Admin, DHHS.

Who pays for Telehealth?

 Federal and state programs  Medicare - with restrictions  Medicaid/ CHIP (SoonerCare) – with restrictions  Private Insurance Programs  Contracted Services

Distant vs Originating

Distant Site :

Where the provider is

Originating Site:

Where the patient is

Authorized originating site

Hospital Office of a physician or practitioner Critical Access Hospitals (CAH) Rural Health Clinics (RHC) Federally Qualified Health Centers (FQHC) Hospital or CAH-based Renal Dialysis Centers (including satellites) School Outpatient Behavioral Health Clinic Community Health Center Indian Health Service facility, a Tribal Health facility, or an Urban Indian Clinic (I/T/U)

Medicare Medicaid

Physician

Authorized distant site specialty Providers

Medicare Medicaid

Advanced Registered Nurse Practitioners Physician Assistants Genetic Counselors Licensed Behavioral Health Professionals Registered Dieticians I/T/U’s with specialty service providers as listed above Nurse midwife Clinical Psychologist Nutrition Professional Clinical Nurse Specialist Clinical Social Worker

Reimbursement Comparison

Medicare Medicaid Private Payer

Pays for telehealth Requires a modifier Patient must be at a rural site* Providers specified Primary Care Only reimburses for specific CPT codes Interactive telecommunication network preapproved Telemedicine visits counted toward the applicable benefit limits for these services Store & Forward Only for I/T/U Non-covered services: telephone conversation, E-mail, FAX Patient must be in Oklahoma at time of teleconsult *Medicare defines “Rural “as a non-MSA county . Medicaid defines “rural “as a county with a population of less than 50,000 people.

Medicaid Telehealth/ Codes

Telehealth Service

Assessment Office or other outpatient visits Behavioral Health Service Plan Development Individual Medical Nutrition Therapy Individual psychotherapy Pharmacologic management Psychiatric diagnostic interview examination and testing

CPT/HCPCS Codes

H0031 99201-99215 H0032 97802-97803 90832-90834, 90837-90838; H0004 Appropriate E/M code 90791-90792;96101-96103;96118 96120; 96110-96111;90887 www.okhca.org

“Soonercare Reimbursement Checklist for Telemedicine”

Telehealth Billing: Medicaid/ Distant Site  Clinical fee services : same as the current fee schedule amount for services provided without telemedicine. Use appropriate HCPS code with modifier.

  Telemedicine/telehealth Modifiers (distant site only):  GT for interactive audio and video telecommunications system

Does not apply to X-ray, ultrasound or electrocardiogram as they are not considered telemedicine.

Dual Eligibles



If a service is eligible under Medicare

 the Medicare payment rate applies and Medicaid would cover some portion of the coinsurance.



If the service isn’t eligible under Medicare

 Confirm with OHCA it is covered  Have the beneficiary sign an Advanced Beneficiary Notice if a Medicaid copayment is required Source: Aaron Fischbach , Policy Coordinator, HRSA

Telehealth Billing: Medicaid/ Originating Site  Originating Site Fee: Originating site must be Rural. Only the originating site will bill for a facility fee.

 HCPCS code "Q3014, ($24.24 in 2012)  “telehealth originating site facility fee"; short description "telehealth facility fee.”  The type of service for the telehealth originating site facility fee is "9, other items & services”

Questions?

Cynthia Scheideman-Miller

[email protected]

Telemedicine/Medicaid specific questions: Adolf Maren

(405)522-7300